Concerning Mpox Cases Surging in the DRC

DLHA Staff writer

Part Africa map showing DRC. Click image to enlarge.

MONDAY, May 20, 2024..The Democratic Republic of Congo (DRC) has been having increasing cases of mpox since November 2023, fueled by a strain with a higher death rate than the variant that spread in Europe and America in 2022. [1]

According to the World Health Organization (WHO), and as of 23 November 2023, the majority of the cases were reported in the central and northern regions of the DRC: Equateur, Mai-Ndombe, Sankuru, and Tshopo. [2]

A total of 18 922 suspected mpox cases including 1007 deaths were reported in the DRC since 2023 to March 29, 2024, meaning that close to 1 in every 20 affected persons have died. [3]

In 2024, and as of 29 March, 4 488 cases have been reported, of which 319 have been confirmed with a total of 279 deaths reported in the country.

The ongoing outbreak of mpox cases is the most widespread as it has been reported in 23 of 26 provinces of the DRC and for the first time in the capital city of Kinshasa.

It is being fueled by a new lethal clade I strain of mpox compared to the less lethal clade II strain that caused a spread to Europe and North America in 2022.

The Crude Fatality Rate (CFR) in 2024 is 6.7%. [3]

According to reports, children younger than 15 years old account for 70% of the total cases and this age group also accounts for 88% of total deaths in the country [3]

Mpox is spread through close personal contact. This typically involves skin-to-skin contact, so sex can often be a means of transmission. [4] Those with HIV are also more vulnerable to severe disease due to weakened immune system

The high incidence of cases among children however is most likely linked to the non-sexual human-to-human transmission route. This route could include household contacts of adults who have contracted the disease through either human-to-human transmission (sexual or non-sexual) or transmission via contact with affected small animals. [5] 

Initial symptoms include fever, chills, exhaustion, headache and muscle weakness, often followed by a rash with lesions that scab over and slowly heal over a period of weeks.

With reports of increased mpox cases in some neighbouring countries of the DRC with frequent air travel connections with Southern Africa, Europe and North America, heightened fears of another more deadly clade I-related global outbreak is considered real by major global health control and prevention authorities who have called for global vigilance .

The CDC for example has alerted U.S. clinicians and public health practitioners to possible cases in travelers from DRC and has requested clade-specific testing.

As at date, no cases of clade I mpox have been reported in the United States or any European country, although one laboratory confirmed case was recently reported in South Africa. [6]

References:

1. European Centre for Disease Prevention and Control Implications for the EU/EEA of the outbreak of mpox caused by Monkeypox virus clade I in the Democratic Republic of the Congo, 5 December 2023. Stockholm: ECDC; 2024. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/Implications-mpox-drc-TAB-erratum.pdf 

2. World Health Organization (WHO). Mpox (monkeypox) - Democratic Republic of the Congo. Geneva: WHO; 2023. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON493

3. Africa CDC Africa CDC Weekly Event Based Surveillance Report, March 2024. Addis Ababa: ACDC; 2024. Available at: https://africacdc.org/download/africa-cdc-weekly-event-based-surveillance-report-march-2024

 4. Kibungu EM, Vakaniaki EH, Kinganda-Lusamaki E, Kalonji-Mukendi T, Pukuta E, Hoff NA, et al. Clade I–associated mpox cases associated with sexual contact, the Democratic Republic of the Congo. Emerging Infectious Diseases. 2024;30(1):172-6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10756366

5. Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. PLoS Neglected Tropical Diseases. 2019;13(10):e0007791. Available at: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007791

6. Datelinehealth Africa. South Africa records a case of mpox disease; nationwide vigilance urged [Internet, 2024 May 17]. Available from: https://www.datelinehealthafrica.org/south-africa-records-a-case-of-mpox-disease-nationwide-vigilance-urged.

Published: May 20, 2024

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